CRITICA

I apologize for replying so late. I would have loved to have written in a more appropriate way, perhaps a shorter and drier version, but I am still at times overwhelmed and find myself spending a lot of energy to regroup with myself and my loved ones. It takes a toll and leaves me with less time for extracurricular clinical activities.

Still, I wish to share what follows, keeping in mind that it has been a very personal experience.

I decided a couple of months ago, more or less based on the known science about this pandemic, that I would not be returning to my in-person clinical work at least until after the August summer break.

I closed my office in the second week of March 2020 after giving one week’s notice to all the patients informing them we would have to move to working remotely. My decision, I have to admit, was based on a very specific feeling of being split.

On one hand, since mid/end of February, my family and friends in Lombardy (Italy) were starting their first quarantine and then quickly after that, was the enforcement of a very strict lockdown. On the other hand, the news in the UK reported that they were struggling to cope with the flood of conflicting information coming both from China and then unlucky Milan and other smaller cities in the then-called red zones.

What I’m saying is that me and some other Italian colleagues and friends in London, were stuck between two unbelievable realities, we were disconcerted and very fearful for our loved ones in Italy, and probably in some sense of denial in London and, consequently struggled with a lack of trust towards the local authorities.

A lot has happened since then, which we know is history now, and the UK is one of the worst-affected countries in the world for Covid-related deaths.

Now, it’s the middle of June and resuming my in-person clinic is clearly not going to work for me from many different perspectives.

My office is in the heart of central London and one can only reach it via public transport, walking for a long time or cycling in the urban jungle). It is located in a building with office spaces, communal spaces and toilets shared with at least other 50 people.

My office itself is very tiny and barely allows the two meters distance from one another now required in the UK. I would have to spend most of my time cleaning and following necessary hygienic procedures, including wearing a mask, and battling myself with feelings of fear and denial of my own safety, as well as concern and worry about my patients as well as how much contact they are having with their families and friends, and so on.

I do not think this is worth the price.

Finally, our insurance companies are still not sure if and how they can cover us in the event of something happening as a direct consequence of Covid-19 in our offices.

In the past (the before the pandemic-era), I had been working with some of my patients remotely; I am used to this practice, have been studying it and publishing about it. Still, I’d like to emphasize that this is a completely different situation.

During this pandemic, remote treatment has become the only possible option since we are living in an emergency; this decision was taken not either by a personal choice, nor that of my patients; it was just the only sensible option to keep everyone safe and going on with our precious analytic work .

This has created a very different and specific transference and countertransference dynamic than when remote treatment is (was) proposed by either the patients (for their specific reasons), or by the analysts (for their own personal reasons/choices). This choice, caused by the pandemic, has a very different impact on our use, evaluation, ‘effects’ and ‘results’ of remote treatments as we had practiced them.

The UK has been severely affected by the pandemic. Covid-19 is not a metaphor. It has been real and is still a concrete threat to people’s health and lives.

All things considered, some of us are privileged in that we are able to keep working with our patients, from the warmth of our own homes and theirs, in some ways a very lucky situation. I am aware this choice will have to be reevaluated in due course depending on the personal and external variants that will arise in the foreseeable future.

In a way, I do not find it so difficult to accept the unknown at the moment. Isn’t the negative capacity so valued in our profession? My patients and I will have to accept this uncertainty for a little longer and follow the scientific developments concerning the pandemic in an atmosphere of “soft communal denial” as Marilia Aisenstein called it in a recent IPA podcast interview, commenting on being able to keep working analytically in our safe remote ‘far away so close’ cyberspace.